A Ped’s Perspective: Blocked Tear Duct
Lacrimal duct stenosis, or a blocked tear duct, is a very common finding in newborns causing a goopy, watery eye(s). Babies do not produce tears right when they are born, so symptoms may not be noticeable until about 2 weeks of life. It can occur in one or both eyes, and the blockage may be present all the time, or the symptoms may come and go. Symptoms are generally worse in the morning when waking up, and after crying.
Although it often mimics characteristics of an infection or “pink eye”, it often is not, and generally does not require antibiotic therapy.
Why does this occur?
Tears occur more often than when babies are just upset. Tears are useful in helping to clean the eye (if something gets in your eye), in response to a stimulant (cold or wind), or to simply lubricate the eye. A blocked tear duct is most often caused because there is a narrowing in the duct that the tears drain into causing them to back up.
Common symptoms:
More tearing than usual: even without crying, tears pool at the corner of the eye(s)
Crusted eyelashes: crusting can appear yellow or green and it does not necessarily indicative of infection.
Mild redness or irritation of the eyes or eyelids: often occurs from rubbing eyes
Supportive measures:
Apply gentle pressure with a clean finger to the inner canthus and move finger in a downward motion down the “bag” of the eye: this will help to manually open the blocked tear duct.
Apply clean warm compresses to wipe away the goopiness
Graphic: UpToDate, Technique for nasolacrimal duct (NLD) massage in infants and children with congenital NLD obstruction (dacryostenosis), UpToDate, Inc., 2023
In most cases, a blocked tear duct does not require treatment, but treatment with antibiotic eye drops may be necessary if increasing discharge occurs. Keep in mind that antibiotic eye drops will treat the possible secondary infection, but it will not fix the underlying problem. More often then not the duct opens spontaneously by 6 months of age, but if the duct does not open spontaneously by one year of life, evaluation for probing is suggested.
Consult with your healthcare provider if you have any questions or concerns; prompt evaluation would be recommended if the eye is swollen shut, if your baby is unable to open or move their eye, or if they have a fever >100.4 without accompanying symptoms.
I hope this helped to provide some reassurance and insight into when you should seek additional medical attention for this common newborn finding.
